Healthcare Provider Details

I. General information

NPI: 1164780946
Provider Name (Legal Business Name): MICHELE AARON FOUTS MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 04/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 RIVERS BEND RD
NEW HAVEN VT
05472-1101
US

IV. Provider business mailing address

87 RIVERS BEND RD
NEW HAVEN VT
05472-1101
US

V. Phone/Fax

Practice location:
  • Phone: 802-388-3887
  • Fax:
Mailing address:
  • Phone: 802-388-3887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0470084103
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: